Menopause

Definition

Menopause is the time in a woman's life when her periods (menstruation) stop. It is a natural, normal body change that most often occurs between ages 45 - 55. After menopause, a woman can no longer become pregnant.

Alternative Names

Perimenopause; Postmenopause

Causes

During menopause, a woman's ovaries stop making eggs. The body produces less of the hormones estrogen and progesterone. Lower levels of these hormones cause menopause symptoms.

Periods occur less often and eventually stop. Sometimes this happens suddenly. But most of the time, periods slowly stop over time.

Menopause is complete when you have not had a period for 1 year. This is called postmenopause. Surgical menopause takes place when surgical treatments cause a drop in estrogen. This can happen if your ovaries are removed.

Menopause can also sometimes be caused by drugs used for chemotherapy or hormone therapy for breast cancer.

Symptoms

Symptoms vary from woman to woman and can be worse for some than others.They may last 5 or more years. Symptoms may be worse for some women than others. Symptoms of surgical menopause can be more severe and start more suddenly.

The first thing you may notice is that periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks before starting to skip periods You may have irregular periods for 1 - 3 years before they stop completely.

Your health care provider will perform a pelvic exam. Decreased estrogen can cause changes in the lining of the vagina.

Bone loss increases during the first few years after your last period. Your doctor may order a bone density test to look for bone loss related to osteoporosis. This bone density test is recommended in all women ages 60 - 65. This test may be recommended sooner if you are at higher risk for osteoporosis because of on your family history or medicines that you take.

Treatment

Treatment may include lifestyle changes or hormone therapy. Treatment depends on many factors such as:

How bad your symptoms are

Your overall health

Your preferences

HORMONE THERAPY

Hormone therapy may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone.

Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical and family history before prescribing hormone therapy (HT).

Several major studies have questioned the health benefits and risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.

Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:

HT may be started in women who have recently entered menopause.

HT should not be used in women who started menopause many years ago, except for vaginal estrogen treatments.

A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream or skin patch rather than a pill)

Frequent and regular pelvic exams and Pap smears to detect problems as early as possible

Frequent and regular physical exams, including breast exams and mammograms

Women who still have a uterus (that is, have not had surgery to remove it for any reason) should take estrogen combined with progesterone to prevent cancer of the lining of the uterus (endometrial cancer).

ALTERNATIVES TO HORMONE THERAPY

There are other medicines that can help with mood swings, hot flashes, and other symptoms. These include:

Possible Complications

Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your health care provider if this occurs. It may be an early sign of other health problems, including cancer.

Decreased estrogen levels have been linked with some long-term effects, including:

When to Contact a Medical Professional

You have had 12 consecutive months with no period and vaginal bleeding or spotting begins again suddenly (even a small amount of bleeding)

Prevention

Menopause is a natural part of a woman's development. It does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:

Control your blood pressure, cholesterol, and other risk factors for heart disease.